Child Psychiatry Flashcards
Review common diagnoses in pediatric mental health
Mood Disorders
Recall first line treatment guidelines
Medications = SSRIs
Fluoxetine (Prozac)
Escitalopram (Lexapro)
treatement as well as behavioral or psychosocial interventions
Major Depressive Disorder:
Persistent Depressive Disorder (dysthymia)
Bipolar Disorder
Disruptive Mood Dysregulation Disorder *
(Bipolar Disorder)
TEST: 2 Exceptions with SIGECAPS:
you have to ask “are you down” or about Irritability, as this may be the predominant emotion that is displayed as opposed to “sad”
epidemiology of mdd in kids and teens:
TEST: by the time you get out of high school, around _______ of kids have had at least 1 depressive episode
Point prevalence: 2% of children, 4-8% of adolescents
Lifetime prevalence by age 18yo: 10-20%- this DOESNT mean lifetime diagnosis, but it means we’re unerrecognizing and undertreating this
10-20%
Genetic Loading
40-60% heritable
First line treatment for MDD:
Psychotherapy (cbt) or IPT (trying to be understanding that if your dad doesn’t show you effection, maybe that’s just him and you have to learn to accept that)
12-16 session with therapis, deep breathing, different things you can do when you’re down
then medication SSRI Fluoxetine down TO AGE 8 escitalopram down TO AGE 12 IF THE KID IS 9, YOU ONLY CAN USE FLUOXITINE!! ONLY 2 APPROVED BY FDA FOR USE ON KIDS NEVER PAROXATINE TCA are shown not to be effective NEVER MAO
TEST: IF THE KID IS 9, and they come to a child psychiatrist with depression, YOU ONLY CAN USE:
Fluoxitine
Children and teens diagnosed with Bipolar Disorder are most likely to meet criteria for which of these disorders in adulthood?
Bipolar Disorder type I
Bipolar Disorder type II
Schizophrenia
Generalized Anxiety Disorder
GAD
once diagnosed with BP, it’s a lifetime sentence and you will be looking at a life long diagnoses with heavy medication
treatment for DMDD:
Stimulants to target impulsive components of disorder
SSRIs for irritability/anger as depression equivalent
Antipsychotics if warranted for aggression and emotion dysregulation symptoms
first line treatment for bipolar
lithium 12+
atypical antipsychotics for 10+ as mood stabilizers
aripiprazole
risperidone
quetiapine
narrow spectrum of diagnosis means that <1% of prepubesent kids are diagnosed with bipolar
Separation Anxiety
Epidemiology:
Prevalence: 4% in children, 1.5% in adolescents
Highly heritable: 73% concordance in twins
Risk factors: sudden attachment disruption, intrusive/overprotective parenting
Diagnosis: Developmentally inappropriate and excessive fear / anxiety about separation from attachment figures
Separation Anxiety
Epidemiology:
Prevalence: 4% in children, 1.5% in adolescents
Highly heritable: 73% concordance in twins
Risk factors: sudden attachment disruption, intrusive/overprotective parenting
Diagnosis: Developmentally inappropriate and excessive fear about things that likely won’t happen “mommy’s going to die” “I might be kidnapped”, etc
“I have a stomach ache I can’t go to school today”
selective mutism
epidemiology:
diagnosis:
0.03-1%
boys=girls=all ethnicities
high comorbidities with social anxiety disorder
failure to speak in social situations that have expectation for speaking
interferes with educational achievement or social function
duration is +1 months
not attributable to lack of knowing/comfort with language
not attributable to communication disorder or asd or psychosis
social anxiety:
over emphasis on being evaluated by your peers
epidemiology:
2-7% 12 month prevalence (grossly underdiagnosed)
2:1 females maybe even higher in adolescents
diagnostic differences from adults:
anxiety must occur w/peers, not just adults
fear/anxiety may be expressed by crying, tantrums, freezing, clinging, shrinking
anxiety in going to the bathroom, eating, waiting in line in public
Not always “I feel too nervous talking to people” so I’m going to hide in the corner (more behavioral)
TEST: PTSD is measured using the:
PTSD presents:
ACE test for “toxic stress”
anything over a 1 is considerable; these are often the big secrets, and you have to build up to talking to them or their parents
TEST: even if you’re not seeing flash backs, and nightmares and rage attacks, you have to be aware that PTSD still causes significant problems for children
TEST: A 5yo child witnessed his mother repeatedly beaten by her boyfriend. Mother’s boyfriend also yelled at him and threatened him regularly. Which of these is true about his PTSD symptoms?
He may not show distress when re-enacting violence through play
He will always wet the bed at night
He will never be violent toward others because he knows what it’s like to be afraid
He will need medication to reduce hyperarousal symptoms at bedtime
He may not show distress when re-enacting violence through play
(always and nevers should always be thrown out)
TEST: PTSD presentation:
Separation of criteria for children under 6yo: may not show distress with intrusions, reenactments
Exposure to trauma not just through electronic media
Intrusive memories or dissociations (flashbacks) may be through repetitive play reenactments
Nightmares may be frightening without discernment of actual content/themes
TEST: when talking about kids under 6 who have PTSD, when talking about them having nightmares, they:
may or may not be frightening, and they may have nothing at all to do with the actual content of themes of what they’ve been traumatized by
TEST: treatment for anxiety disorders is to:
graduate exposure to the fear. The treatment is to FACE the fear, not learning ways to avoid the fear, bc if you avoid it , it gets scarrier.
Social anxiety is the same: 1st step: go to starbucks and sit around othe people;
for kids, it’s different, go up to one kid and say hi and walk away. Step 2, say “nice shirt” then walk away, etc
TEST: CBT for Anxiety or PTSD is all about:
not FORGETTING the trauma, but to integrate that trauma into their own sense of self. This happened to me, it wasn’t ok, and when I think of it, I will not let it crush me
TEST: the medicatino of choice for anxiety and everything else:
fluoxetine (prozac), sertraline (zoloft), NOT TCAs
NOTE: fluoxetine and sertraline are probably even better for anxiety than they are depression, but they were labeled antidepressents first
xanex, adavan, closapane, valium- worst possible thing you can do (great for short term or once a week , horrible long term- never used with kids, period
OCD:
epidemiology:
why?
First line?
1-2%, males earlier age, 25% by age 10yo
when appearing in childhood, it’s much more likely that there is a genetic component, but nothing identified (polygenic)
CBT, SSRI
only time TCA are possibly helpful
Oppositional Defiant Disorder:
dennis the menace temper, angry argues, refuses to comply
Conduct disorder:
Only treatment:
fights, uses weapons, physically cruel, steals, deliberately destroys peoples’ property, runs away, truant from school
not “I’m an annoying brat” I’m actually beating people, etc: (just a spectrum of severity- oppositional defiant disorder is kind of bad, conduct disorder is worse)
Try to teach parent to set stricter limits and enforce them!
TEST: 2003, there was a black box label put on ssris in teens because:
Therefore, the number of prescriptions went____ and :
there was a 2x increase in suicidal ideation in 1 study. Went from 2%-4%, and it was NOT an increase in actual suicide, or anything else, only an increase in thoughts
prescriptions went down and the suicide rate INCREASED!
TEST: regarding medication for child psychiatry:
children are often UNDER dosed (need to go lower or higher)
TEST: _____ is the ssri contraindicated for kids
paroxatine
